Interpretive Summary: The use of certain medications such as diuretics or water pills has been linked to excessive loss of some water-soluble vitamins such as thiamin. Low levels of thiamin can lead to loss of appetite and other problems. Homebound elders who receive home-delivered meals were found to be high users of diuretics and also to have low dietary intake of thiamin, placing them at risk of serious problems that could be avoided or eased by careful nutrition monitoring.

Technical Abstract:
Although diuretic therapy (DT), which plays a major role in disease management, may increase thiamin excretion, little attention has been paid to the linkage between DT use and dietary intake of thiamin, especially in nutritionally vulnerable elders. Thiamin deficiency may develop in a short period of time, may severely depress intake, and may be misdiagnosed as worsening of underlying disease. The purpose of this study was to assess the relationship between DT use and dietary intake of thiamin in a randomly-recruited sample of homebound elders. Baseline data, including three 24-hour recalls, from the Nutrition and Function study were used to identify thiamin intake from food (15% <EAR and 33%<RDA), DT use (51%) and meal pattern (18% not regularly eating breakfast) in 327 homebound recipients of home-delivered meals (aged 61-98 years), 49% African-American, 81% female, and 65% income <$750/month). Independent of socio-demographic and meal pattern variables, DT users (relative to nonusers) were at increased odds for dietary thiamin intake <RDA (OR = 2,3) and <EAR (OR = 4.2). Considering the importance of home-delivered meals as a primary source of food assistance to homebound elders and that thiamin deficiency may exacerbate health problems, the results of this study suggest the need to include information on DT use as an integral component of program assessment for the targeting and monitoring of new, innovative, and cost effective strategies to alleviate the risk for deficiency.